Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery

Catherine Y. Spong*, Paul J. Meis, Elizabeth A. Thom, Baha Sibai, Mitchell P. Dombrowski, Atef H. Moawad, John C. Hauth, Jay D. Iams, Michael W. Varner, Steve N. Caritis, Mary J. O'Sullivan, Menachem Miodovnik, Kenneth J. Leveno, Deborah Conway, Ronald J. Wapner, Marshall Carpenter, Brian Mercer, Susan M. Ramin, John M. Thorp, Alan M PeacemanSteven Gabbe

*Corresponding author for this work

Research output: Contribution to journalArticle

73 Scopus citations

Abstract

Objective: Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17-alpha hydroxyprogesterone caproate (17-OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17-OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17-OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20-27.9, 28-33.9 vs 34-36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17-OHP caproate versus placebo. Effectiveness of 17-OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20-27.9, 28-33.9, and 34-36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17-OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17-OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver <37 weeks (42% vs 63%, P = .026 and 34% vs 56%, P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17-OHP caproate or control. Conclusion: 17-OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at <34 weeks.

Original languageEnglish (US)
Pages (from-to)1127-1131
Number of pages5
JournalAmerican journal of obstetrics and gynecology
Volume193
Issue number3 SUPPL.
DOIs
StatePublished - Sep 1 2005

Keywords

  • Preterm birth
  • Prevention
  • Progesterone
  • Recurrent preterm birth

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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    Spong, C. Y., Meis, P. J., Thom, E. A., Sibai, B., Dombrowski, M. P., Moawad, A. H., Hauth, J. C., Iams, J. D., Varner, M. W., Caritis, S. N., O'Sullivan, M. J., Miodovnik, M., Leveno, K. J., Conway, D., Wapner, R. J., Carpenter, M., Mercer, B., Ramin, S. M., Thorp, J. M., ... Gabbe, S. (2005). Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery. American journal of obstetrics and gynecology, 193(3 SUPPL.), 1127-1131. https://doi.org/10.1016/j.ajog.2005.05.077